HomeMy WebLinkAbout19M09 CAMPAIGN TREASURER'S REPORT SUMMARY
Name City o`
OFFICE
a Y
(�) I � � � � Rec;wee.
i^ he ffice of tie City CI
11/lr/ !�/ S t Date:
Address (number and street) T _
City, State, Zip Code
❑ Check here If address has changed (3) ID Number:
(4) Check appropriate box(es):
L.td'Candidate Office Sought:
❑ Political Committee(PC)
❑ Electioneering Communications Org. (ECO) ❑Check here If PC or ECO has disbanded
❑ Party Executive Committee(PTY) ❑Check here if PTY has disbanded
❑ Independent Expenditure(IE)(also covers an ❑Check here if no other IE or EC reports will be filed
individual making electioneering communications)
(5) Report Identifiers
Cover Period: From To L� / 'e / 1 rt Report Type:
[Original El Amendment ❑Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ 0 . c Expenditures $ H '
Loans $ C9 Transfers to
Office Account $
Total Monetary $ • _ 9 o
Total Monetary $
In-Kind $ � � � 0
(8) Other Distributions
$ ,
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ $
(11) Certification
It is a first degree misdemeanor for any person to falsify a public record(ss.839.13, F.S.)
I certify that I have examined this report and it is true,correct,and complete:
(Type name) (Type name) 1' 'Q
ndivldual(only for IE ❑Treasurer ❑Deputy Treasurer [Candidate ❑Chairperson(only for PC and PTY)
or electioneering comm.)
f
Signature Signature
DS-DE 12(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT— ITEMIZED EXPENDITURES
(1) Name-A I h e 7 (2)I.D. Number
(3)Cover Period_J_/ / 11 through l f l l 1 (4)Page ( of
(5) (7) (S) (9) (10) (11)
Date Full Name Purpose
(6) (Last,Suffix,First,Middle) (add office sought if
Sequence Street Address& contribution to a Expenditure
Number City,State,Zip Code candidate) Type Amendment Amount
LV
g (�
1�M
DS-DE 14(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT- ITEMIZED CONTRIBUTIONS
(1) Name J/; (2) I.D. Number
(3) Cover Period 4 / ( / 14 through `) / j O (4) Page of
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last,Suffix,First,Middle)
Sequence Street Address& Contributor Contribution In-kind
Number City,State,Zip Code Type Occupation Type Description Amendment Amount
DS-DE 13(Rev.11113) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES